Employment Application
Personal
Education
References
Employment
Finish
Thank you for showing your interest in working with MCOP.
Please check below for available employment opportunities and send us your application by completing the application form.
First Name
Last Name
M.I.
Today's Date
Address
Apt/Unit #
City
State
ZIP
Phone
Email
Social Security No.
What position are you applying for?
Date Available
Desired Salary($)
Are you willing and able to work full-time?
Yes
No
Are you willing and able to work part-time?
Yes
No
Are you a citizen of the United States?
Yes
No
If no, are you authorized to work in the U.S.?
Yes
No
Are you over the age of 18?
Yes
No
If you are not over the age of 18, you may be required to provide work authorization.
Have you ever worked for this company?
Yes
No
If yes, when?
Do you have any friends or relatives who work for the company?
Yes
No
If yes, who?
Have you ever done any volunteer work?
Yes
No
If yes, describe.
High School
Location
Dates
Did you graduate?
Yes
No
Diploma
College
Location
Dates
Did you graduate?
Yes
No
Degree
Other
Location
Dates
Did you graduate?
Yes
No
Degree
Have you completed any special courses, seminars, and/or training directly related to the position for which you are applying?
Yes
No
If yes, describe.
Do you belong to any professional, trade, business, or civic organizations that deal with the position for which you are applying?
Yes
No
If yes, describe.
Please list three professional and/or personal references.
Reference #1
Company
Relationship
Address
Phone
Reference #2
Company
Relationship
Address
Phone
Reference #3
Company
Relationship
Address
Phone
Please list the details of your previous employment.
Company
Address
Phone
Supervisor
Job Title
Start Date
End Date
Responsibilities
Reason for Leaving
May MCOP contact the previous supervisor listed above for a reference?
Yes
No
Company
Address
Phone
Supervisor
Job Title
Start Date
End Date
Responsibilities
Reason for Leaving
May MCOP contact the previous supervisor listed above for a reference?
Yes
No
Company
Address
Phone
Supervisor
Job Title
Start Date
End Date
Responsibilities
Reason for Leaving
May MCOP contact the previous supervisor listed above for a reference?
Yes
No
Applicant Certification and Agreement
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge, and I authorize MCOP to verify their accuracy and to obtain reference information on my work performance. I hereby release MCOP from any and all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.
I understand that, if offered employment, falsified statements or omissions of any kind called for on this application shall be considered sufficient basis for dismissal.
Should I be extended an offer of employment, I agree to fully adhere to policies, rules, and regulations of employment as defined by the Employer should I accept the offered position. I further understand that neither the policies, rules, and regulations of employment, nor anything said during the interview process shall be deemed to constitute terms of an implied contract. I understand that any employment offered is at will for an indefinite duration, and that either the Employer or myself may terminate my employment at any time with or without notice or cause.
Signature
Date
Applications for Employment are valid for 60 days from the date of above signature.
Monroe County Opportunity Program is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, veteran status, genetic information, or any other characteristic protected by law.
Thank you for submitting your application.
We will contact you if we need additional information.
SUBMITTED!